Values, Policies and Rights

United Towards Achieving Health For All in Kenya
Kariuku S; Chatterjee S: Reliefweb, 2018

Of all the Sustainable Development Goals, few would rival good health as the definition of a country that has a sustainable, inclusive, peaceful and prosperous future. The authors observe that the launch in December 2018 of the pilot phase of Kenya’s journey towards Universal Health Coverage (UHC) heralds a major step towards that future. In Kenya, health-related expenses are driving about one million into poverty every year, and health care is second only in demand on family spending to food in family budgets. Kenya announced that UHC will involve scaling up immunization, prevention of water borne, vector borne, TB, HIV and sexually transmitted diseases, improving maternal and child health as well as nutrition of pregnant women. Kenya will also focus on prevention of non-communicable diseases like diabetes and hypertension. With Kenya’s Vision 2030 ambition of providing a high quality of life to all its citizens, the most urgent need is argued to be that of ensuring that everyone stays healthy to participate in economic development.

How courts are failing the mentally ill
Kwagala P: New Vision, Uganda, 2018

The author outlines a court case in which the judgment raises concerns that some judicial officers hold deeply misguided notions regarding people with mental health issues, which deprives them of access to justice. Such attitudes are noted to not be restricted to judicial practitioners and discrimination to be nationwide. The judiciary as protectors of the rule of law are argued to be held to a higher standard. In 2014, Mental Health Uganda and Validity (formerly the Mental Disability Advocacy Centre – MDAC) published research uncovering widespread abuse, ill-treatment and appalling conditions in Uganda’s regional mental health facilities as well as Butabika. The research also investigated the experiences of people in their communities. The report found that most people with mental health issues experience high levels of violence and neglect at the hands of community members and public officials. The lack of local community mental health and psychosocial support services meant that many found themselves pushed towards unregulated traditional and faith-based healers. Many people recounted having endured unspeakably cruel practices including chaining, cutting the skin, being tied to trees, beatings and daily, casual prejudice. The author argues that the law needs to ensure people can access consensual mental health treatment in the community, with the aim of supporting independence and social inclusion.

Antibiotic resistance has a language problem
Mendelson M; Balasegaram M; Jinks T: Nature, May 2017

Clinicians have long known that microbes such as bacteria, viruses and fungi are becoming alarmingly resistant to the medicines used to treat them. But a global response to this complex health threat — commonly termed 'antimicrobial resistance' — requires engagement from a much broader array of players, from governments, regulators and the public, to experts in health, food, the environment, economics, trade and industry. The authors argue that people from these disparate domains are talking past each other. Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations. In 2017, the United Nations formed an interagency group to coordinate the fight against drug resistance urging that, as one of its first steps, the group coordinate a review of the terminology used by key actors. They proposed that drug-resistant infection be the overarching term used (in English) to describe infections caused by organisms that are resistant to treatment, including those caused by bacteria that do not respond to antibiotics. They also noted that a blame narrative is unhelpful, failing to acknowledge symbiotic relationships with bacteria. Because terminology has geographic, disciplinary and societal variations that affect understanding and interpretation, research is argued to be needed to optimize the lexicon across different countries and languages.

Heads of State commit to lead response to beat noncommunicable diseases, promote mental health
World Health Organisation: WHO, Geneva, 2018

Heads of state and government in September 2018 committed to 13 new steps to tackle non-communicable diseases including cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well-being. World leaders agreed to take responsibility themselves for their countries’ effort to prevent and treat NCDs. They also agreed that these efforts should include robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks. They committed to implement a series of WHO-recommended policies to prevent and control of NCDs - such as public education and awareness campaigns to promote healthier lifestyles, vaccinating against HPV virus to protect against cervical cancer and treating hypertension and diabetes. WHO estimates that implementing all these policies could generate US$ 350 billion in economic growth in low and lower-middle-income countries between now and 2030. Other specific commitments focus on halting the rise of childhood obesity, promoting regular physical activity, reducing air pollution and improving mental health and wellbeing. The political declaration reaffirms WHO’s global leadership of the fight to beat NCDs and promote mental health, and urges the Organization to continue working closely with key partners, including government, civil society and the private sector. In particular, it calls on food manufacturers to take several actions. These include reformulating products to reduce salt, free sugars and saturated and industrially produced trans fats, using nutrition labelling on packaged food to inform consumers, and restricting the marketing of unhealthy foods and beverages to children.

New Global Commitment to Primary Health Care for all at Astana Conference
Fernandez M: UNICEF, New York, 2018

In October 2018, United Nations Member States unanimously agreed to the Declaration of Astana, vowing to strengthen their primary health care systems as an essential step toward achieving universal health coverage. The Declaration of Astana reaffirms the historic 1978 Declaration of Alma-Ata, the first time world leaders committed to primary health care. The Declaration of Astana comes amid a growing global movement for greater investment in primary health care to achieve universal health coverage. Health resources have been overwhelmingly focused on single disease interventions rather than strong, comprehensive health systems – a gap highlighted by several health emergencies in recent years. The author reports that UNICEF and WHO will help governments and civil society to act on the Declaration of Astana and encourage them to back the movement and will support countries in reviewing the implementation of this Declaration, in cooperation with other partners.

UN International Day For Older Persons Celebrated In Marondera, Zimbabwe
263 Chat: Marondera, Zimbabwe, November 2018,

The United Nations International Day for Older Persons falls on 1 October every year. This year it was commemorated under the theme celebrating older human rights champions. Belated commemorations were held on Friday 23 November 2018 at Mahusekwa district hospital in Marondera, Zimbabwe. Representatives from the District Administrator’s office, the Ministry of Public Service Labour and Social Services, Ministry of Health and Child Care, the National Age Network of Zimbabwe (NANZ), chiefs, the private sector, NGOs, older people representative organisations and older people champions among others were in attendance. In line with celebrating older human rights champions the event was run and owned by older persons with Gogo Mufuta and Gogo Nyamande sharing the master of ceremonies platform. Speeches centred on the important role that older people play in society emphasising their role as custodians of culture. Older people were also noted to be key carers of orphaned and vulnerable children. Dr Guvheya, the former chairman of the Zimbabwe Older Persons Association (ZOPO) praised the constitution which enshrines the rights of older people. He challenged government to operationalize provisions of the constitution and other pieces of legislation to enable older people to enjoy their rights. Dr Guvheya also spoke about the challenges faced by older people, including witchcraft accusations and property grabbing. He lamented on the current environment where pharmacies are demanding payment in foreign currency for medicines. This point was emphasised throughout the day as older people are in need of holistic health care and support as many are living with diseases including HIV, cancer, diabetes and dementia yet they have lost the capacity to generate income to access health services.

Alternative Civil Society Astana Statement on Primary Health Care
Public interest civil society organisations and social movements: open for endorsements up to 15 November

Members of public interest civil society organisations and social movements, some of whom are participants at the Global Conference on Primary Health Care, produced this statement to re-affirm a commitment to primary health care (PHC) in pursuit of health and well-being for all, aiming to achieve equity in health outcomes. The statement is a re-affirmation of the Alma Ata declaration, which to PHM and others remains the ultimate declaration on primary health care; the principles are clear and remain relevant. This authors invite organisations who agree with the views expressed to sign on to the statement.

How a change in US abortion policy reverberated around the globe
Bearak M; Morello C: The Washington Post, October 2018

In January 2017, President Trump signed an executive order that denied U.S. assistance to any foreign-based organization that performs, promotes or offers information on abortion. A similar policy was in effect under past Republican presidents. In 2017 it was expanded exponentially to apply not just to around $600 million in overseas family-planning funds, but to the entire $8.8 billion in annual U.S. global health aid. It will take years to gauge the full impact of the policy, which will affect aid groups as they renew grants or seek new U.S. funding. More broadly, the policy has created a wave of uncertainty in aid-dependent countries. For the first time, groups that treat HIV, malaria and other illnesses will also have to pledge to have no role in promoting abortion — or forgo American aid. Academics have questioned whether the policy effectively decreases abortions. A 2011 study by Stanford University researchers suggested the policy has actually been “associated with increases in abortion rates in sub-Saharan African countries.” One possible reason the researchers gave for this was that some organizations that had provided contraceptives lost funding, which may have led to more unwanted pregnancies. While most foreign health groups have committed to following the new rules., a small group , including the International Planned Parenthood Federation and Marie Stopes, have refused to sign.

Influence of the WHO framework convention on tobacco control on tobacco legislation and policies in sub-Saharan Africa
Wisdom J; Juma P; Mwagomba B: BMC Public Health 18(Suppl 1) 954, doi: https://doi.org/10.1186/s12889-018-5827-5, 2018

The World Health Organization’s Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control. A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. It involved document review and key informant interviews. Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country’s socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.

Press release on prosecution of SGBC in Uganda
Kwagala P: Centre for Health, Human Rights & Development, 2018

In August 2018, the Center for Health, Human Rights and Development (CEHURD), Nnamala Mary and Simon Kakeeto took the Government of Uganda to the Constitutional Court for failing to put in place shelters for women who have been raped or defiled. CEHURD challenged the unequal punishments that the law provides for sexual offenders as being unjust. Men charged with rape are liable to suffer a maximum penalty of death whereas the law provides for the offense of ‘defilement’ for persons between the ages of 14-17 and sexual offenders against girls of that category are only given a few years of a jail term. This difference in penalties towards perpetrators who commit the same offense was argued to be unjust and to offend the principle of equality and non-discrimination before the law. It was also observed to have an effect of increasing sexual violence against girls in that particular age group. Women who survive sexual violence need safe spaces, shelters and refuge. The Ugandan Constitution mandates the State to put in place facilities to enhance the welfare of women to enable them to realise their full potential and advancement. It was thus CEHURD's contention that failure by government to construct and finance these shelters is a clear violation of women’s rights guaranteed under article 33(2) of the 1995 Constitution of Uganda.

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